Serial measurement of Doppler hepatic hemodynamic parameters for the diagnosis of acute rejection after live donor liver transplantation

Abstract

To elucidate the role of Doppler hepatic hemodynamic parameters as surrogate markers of acute rejection (AR) after live donor liver transplantation (LDLT), serial Doppler measurements were prospectively performed during the first 2 weeks after LDLT to compare the longitudinal hepatic hemodynamic changes between patients with histologically proven AR and patients without histologically proven AR. Forty-six patients that had undergone adult-to-adult LDLT using a right lobe graft were enrolled in this study. The portal venous maximum velocity (PVV; cm/second), portal venous flow volume, hepatic arterial peak systolic velocity, hepatic arterial pulsatility index, hepatic venous maximum velocity, hepatic venous pulsatility index, and splenic arterial pulsatility index were measured. Fourteen patients were diagnosed by biopsy to have clinically relevant AR. Markedly increased PVV was seen soon after surgery and gradually decreased in both patients with clinically relevant AR and patients without clinically relevant AR. This serial change of decreasing PVV was significantly greater in patients with clinically relevant AR (P Ͻ 0.0001). After postoperative day 6, the PVV in patients with clinically relevant AR was significantly lower than that in patients without clinically relevant AR (PVV on postoperative day 6: 35.6 Ϯ 21.3 versus 58.3 Ϯ 27.1 cm/second, respectively, P ϭ 0.0080). A PVV cutoff value of 20.2 cm/second demonstrated the best accuracy for predicting clinically relevant AR. The sensitivity and specificity for predicting clinically relevant AR were 92.9% and 87.1%, respectively. The area under the curve was 0.94. In conclusion, serial Doppler measurement of hepatic parameters in LDLT is useful for the diagnosis of clinically relevant AR. Clinically relevant AR should therefore be suspected when a marked unexpected decrease in the PVV is observed. Liver Transpl 15:1119-1125, 2009. © 2009 AASLD. Received October 15, 2008 accepted February 25, 2009. Acute rejection (AR) after live donor liver transplantation (LDLT) is one of the most common clinical problems and often happens 5 to 10 days postoperatively.

US‐Guided Percutaneous Liver Biopsy in Pediatric Liver Transplant Recipients

“…Not surprisingly, bile duct dilatation and cholestasis were correlated (RRR = 7.7); however, because of the large CI (2–29), the result is not precise. Some studies have demonstrated relations between US parameters, mainly hepatic vein waveforms and portal blood velocity, and acute rejection typically within 2 weeks after transplantation (11,13,15,16); however, the contrary has also been reported (14). Study methods and definitions, cohorts, and timing of biopsy posttransplantation likely account for variability in these results and those of our study.…”

“…What is understood in adult cohorts is that standard LFTs do not correlate well in many cases of grading the severity of liver graft dysfunction (6)(7)(8). Similarly, Doppler US variables have been investigated as predictors of posttransplantation liver rejection, but these studies have used mostly or exclusively adult cohorts, focused on the time period within 2 weeks or shortly after transplantation, and/or preceded an international consensus of defining rejection (9)(10)(11)(12)(13)(14)(15)(16).…”

Hematological and biochemical characteristics and diagnostic imaging results in acute T cell–mediated rejection after pediatric liver transplantation

“…However, the relationship between bilirubin levels and In Doppler ultrasonographic measurements, MHVV was associated with TCMR and histological central venulitis. Previous studies have shown that PHVV at postoperative day 5 and hepatic vein wave form were associated with acute TCMR, 21,[32][33][34] and the relationship between MHVV and acute TCME has not been studied. Globular swelling severity and luminal narrowing of the hepatic vein on computed tomography scan were found to be associated with increases in the risk of acute TCMR because histopathological inflammation alters hepatic compliance and leads to graft swelling.…”

Echography in liver transplantation: a literature review

“…Имеются трудности верификации этого процесса и при использовании визуализаионных, в том числе и ультразвуковых методов диагностики [31]. Исследователями не найдено достоверных ДГ признаков его подтверждения [29,40]. В то же время, Martino M.D.…”